Ch 6 - Prosthetic and Orthotics: Lower Limb Orthoses Flashcards

1
Q

Where is the COG while standing?

A

Midline and just anterior to the S2 vertebra

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2
Q

What is the Line of gravity (weight line)?

A

Line passing through the COG to the ground

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3
Q

How many points of pressure are needed in orthotic devices?

A

3 points of pressure are needed for proper control of a joint

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4
Q

Where does the line of gravity pass through the spine?

A

Behind the cervical vertebrae, in front of the thoracic vertebrae, and behind the lumbar vertebrae

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5
Q

Where does the line of gravity pass through the hip?

A

Slightly posterior to the hip joint and tends to passively extend the hip joint

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6
Q

Where does the line of gravity pass through the knee?

A

Anterior to the knee joint and tends to passively extend the knee

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7
Q

Where does the line of gravity pass through the ankle?

A

1 to 2 inches anterior to the ankle joint and tends to dorsiflex the ankle

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8
Q

During the “quiet” standing phase, where does the line of gravity pass?

A
  • Posterior to hip joint
  • Anterior to knee joint
  • Anterior to ankle joint
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9
Q

How are Thermoplastics molded?

A

Soften and become moldable when heated

– Cold-temp can be molded at temp just above body temp (< 80°C or < 180°F)

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10
Q

What are AFO’s used for?

A

Weakness affecting the ankle and subtalar joints

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11
Q

What are Posterior leaf spring AFO’s used for?

A

Flaccid foot drop

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12
Q

Describe a Posterior leaf spring AFO.

A

Very thin plastic band behind the ankle allowing the patient to overpower the brace during push-off/plantar flexion phase, yet allowing dorsiflexion assist and positioning of the foot during swing phase

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13
Q

Describe a Semirigid plastic AFO.

A

Trim line is just behind the malleoli and provides increased
mediolateral stability of the ankle and dorsiflexion positioning of the foot

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14
Q

What is a Semirigid plastic AFO used for?

A

Foot drop with some extensor tone and/ or mediolateral instability of the ankle

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15
Q

Describe a Rigid (solid) plastic AFO.

A

Trim line at the malleoli or anterior to the malleoli with no motion allowed at the tibiotalar or subtalar joint

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16
Q

What is a Rigid (solid) plastic AFO used for?

A

Highest levels of spasticity/tone
Complete immobilization of the ankle (post op)
Early to moderate Charcot joint

17
Q

What is a Klenzak joint?

A

Inserting a spring in the single channel ankle for dorsiflexion assist

18
Q

What are the 3 options of a Single Channel ankle joint?

A

– Spring for dorsiflexion assist
– Steel pin for plantar flexion stop
– Both a pin and a spring for dorsiflexion assist and plantar flexion stop

19
Q

What does a pin in the anterior dual channel ankle joint do?

A

Block the forward progression of the tibia at midstance (dorsiflexion stop), or to lock the joint in a fixed position

20
Q

In what pts is a pin in the anterior dual channel ankle joint used?

A

Quadriceps muscle is weak

Charcot joint deformity at the ankle

21
Q

Describe a free motion knee joint KAFO.

A

Free motion knee joint provides unlimited flexion but usually has a stop to prevent hyperextension

22
Q

In what pts is a free motion knee joint KAFO used?

A

Patients with genu recurvatum but with enough strength to control the knee in stance and ambulation

23
Q

Describe an offset knee joint KAFO.

A

Hinge posterior to the knee joint so the patient’s weight line falls anterior joint, stabilizing the knee during early stance phase

24
Q

In what pt should an offset knee joint KAFO not be used?

A

Knee or hip flexion contractures

Plantar flexion stop at the ankle

25
Q

What is a good KAFO to use in an obese patient with quadriceps weakness?

A

KAFO with double metal uprights and posterior offset knee joint

26
Q

Describe a polycentric knee joint for a KAFO.

A

Provides unlimited knee flexion and extension but has significant added weight and components that require maintenance

27
Q

What is a Scott-Craig orthosis?

A

Bilateral KAFOs designed for standing and ambulation in adults with paraplegia

28
Q

Who is a Scott-Craig orthosis used for?

A

Complete neurological level at L1 or lower with a more functional and comfortable gait

29
Q

How is Unsupported standing possible with Scott-Craig orthoses?

A

Ankles and knees locked, hip stabilization by leaning trunk backwards so COG of the trunk rests posterior to the hip joint, resulting in tightening of the anterior hip capsule and the “Y” ligament

30
Q

How do patients ambulate with Scott-Craig orthoses?

A

Crutches or walker using a swing-to or swing-through pattern gait

31
Q

When is a Reciprocal gait orthosis used?

A

Upper lumbar paralysis in which active hip flexion is preserved

32
Q

What does a Reciprocal gait orthosis consist of?

A

Bilateral HKAFOs with offset knee joints with drop locks, posterior plastic AFOs, thigh pieces, custom-molded pelvic girdle, hip joints, and a thoracic extension with Velcro straps

33
Q

What does a sagittal plane knee orthosis provide?

A

Limits hyperextension of the knee (genu recurvatum)

34
Q

What does a axial rotation knee orthosis provide?

A

Mediolateral and axial control

35
Q

What does a coronal plane knee orthosis provide?

A

Mimics anatomic knee joint function

36
Q

What does adding a footplate to knee immobilizer do?

A

Dec rotational instability of the knee

37
Q

What is a Swedish Knee cage used for?

A

Controls minor to moderate knee hyperextension/ genu recurvatum due to ligamentous or capsular laxity

38
Q

What is a Lenox-Hill derotation orthosis?

A

Knee orthosis designed for control of knee axial rotation in addition to anterior-posterior and medial-lateral control

39
Q

What is a Lenox-Hill derotation orthosis used for?

A

Protection and management of sports injuries to the knee (ACL injuries)